Continuum (Minneap Minn). 2022 Oct 1;28(5):1314-1332. doi: 10.1212/CON.0000000000001151.
This article summarizes the underlying biology and current diagnostic and treatment strategies for the cognitive and neuropsychiatric features of Parkinson disease (PD) and dementia with Lewy bodies (DLB).
Cognitive impairment and neuropsychiatric symptoms have been increasingly recognized in PD and DLB, leading to improved diagnosis and treatment strategies. While PD is most associated with and diagnosed by the presence of motor symptoms, nonmotor symptoms can often be the most debilitating for patients. Neuropsychiatric symptoms are highly prevalent nonmotor features and include cognitive impairment, depression, anxiety, psychosis, impulse control disorders, and apathy. Neuropsychiatric symptoms can be difficult to recognize and diagnose in patients with PD, in part because of comorbidity and symptom overlap with core PD features. Treatment strategies are a combination of pharmacologic and nonpharmacologic interventions used in the general population and those specific to PD. DLB is a clinical dementia syndrome, often with similar cognitive, behavioral, autonomic, and motor features as PD. Moreover, DLB has shared underlying pathophysiology with PD, as both are associated with postmortem findings of α-synuclein neuropathology at autopsy and have shared genetic risk and prodromal symptoms. DLB is clinically differentiated from PD by the presenting features of cognitive impairment in DLB, compared with the variable onset of cognitive impairment occurring 1 year or more after established motor onset in PD. Thus, diagnosis and treatment of cognitive impairment and neuropsychiatric symptoms in DLB are similar to that of PD and have important implications for maintaining patient independence and providing support for caregivers because motor, cognitive, and neuropsychiatric symptoms have an additive effect on patient functional disability.
A careful history and physical examination are often needed to accurately diagnose and treat the heterogeneous cognitive and behavioral symptoms of PD and DLB. Accurate diagnosis and treatment of neuropsychiatric symptoms and cognitive impairment in PD and DLB are important, as these are a considerable source of patient disability and caregiver burden.
本文总结了帕金森病（PD）和路易体痴呆（DLB）认知和神经精神特征的潜在生物学以及当前的诊断和治疗策略。
认知障碍和神经精神症状在 PD 和 DLB 中越来越受到重视，从而改善了诊断和治疗策略。虽然 PD 最常与运动症状相关，并通过运动症状来诊断，但非运动症状往往对患者的影响最大。神经精神症状是高度普遍的非运动特征，包括认知障碍、抑郁、焦虑、精神病、冲动控制障碍和冷漠。PD 患者的神经精神症状很难识别和诊断，部分原因是共病和与 PD 核心特征的症状重叠。治疗策略是一般人群中使用的药物和非药物干预措施的组合，以及针对 PD 的特定治疗策略。DLB 是一种临床痴呆综合征，其认知、行为、自主和运动特征通常与 PD 相似。此外，DLB 与 PD 具有相似的潜在病理生理学，因为两者都与死后α-突触核蛋白神经病理学发现相关，并具有共同的遗传风险和前驱症状。与 PD 相比，DLB 以认知障碍为主要表现，而 PD 以认知障碍的发病时间不同，PD 的认知障碍在确诊运动障碍 1 年或更长时间后才出现。因此，DLB 认知障碍和神经精神症状的诊断和治疗与 PD 相似，对维持患者独立性和为照顾者提供支持具有重要意义，因为运动、认知和神经精神症状对患者的功能残疾有累加效应。
为了准确诊断和治疗 PD 和 DLB 异质的认知和行为症状，通常需要进行仔细的病史询问和身体检查。准确诊断和治疗 PD 和 DLB 的神经精神症状和认知障碍非常重要，因为这些是导致患者残疾和照顾者负担的重要原因。
